Completely analogous material is afforded by cases, in which in healthy people a splenectomy has been necessary in consequence of trauma. Unfortunately the material available for this purpose is extremely rare; and it would be of the utmost value if the alterations of the blood in such a case were systematically studied for a period of years. We have ourselves begun our observations in two patients directly after the operation, but were unable to continue them, as death occurred within the first week after the extirpation. Up to the present only seven cases of rupture of the spleen with subsequent splenectomy have been published, as is stated in the collection of cases of v. Beck. In two only, of these seven cases, one of Riequer's (Breslau) the other of v. Beck's (Karlsruhe) was a cure effected. Through the courtesy of the above-mentioned gentlemen, we were able to investigate specimens from these two patients.
In the case of v. Beck the operation was performed on June 15, 1897. We received a dry blood preparation about 6 months after operation. Investigation showed a considerable lymphæmia: the bulk of the lymphocytes belonged to the larger kinds: the eosinophil cells were certainly not increased. For other reasons an exact numerical analysis could not be undertaken. We hope to be able to follow the further course of this case.
In the second case the operation was performed on May 17, 1892, by Dr Riequer of Breslau, for trauma, and later described. We made counts in oldish and fresh preparations. It is worthy of notice that this case is not uncomplicated, as an amputation of the thigh was performed shortly after the splenectomy on account of gangrene.
------------------------------------------------------------------------ Preparations from | Polynuclear | Lymphocytes | Eosinophil | Large | | | | mononuclear ------------------------------------------------------------------------ June 12, 1892 | 81.9% | 15.9% | 1.3% | -- October 11, 1892 | 80.0% | 13.7% | 4.0% | 1.7% September, 1897 | 56.8% | 33.1% | 3.5% | 1.5% ------------------------------------------------------------------------
It is much to be regretted that dry preparations only at the beginning and at the end of the five year period of observation were at our disposal. It appears from the paper of Riequer as if in this case the lymphocytosis had established itself one month after the operation, and had lasted for a very long time, just as Kurloff has found in some animal experiments. Just as little as a polynuclear increase is abnormal, is an increase of the lymphocytes remarkable; and in this case the lymphocytic increase was recognisable after the end of the fifth year. The eosinophil cells oscillate at this period about the upper normal limit. From all that we know, it is probable that their number in the meantime had undergone an intercurrent increase.